When submitting a hospital informational only claim with the 04 condition code, are charges submitted as covered or non-covered?
Charges are submitted as covered. Patients who are enrolled in Medicare Advantage (administered through Medicare Part C) should also be included in the Medicare fraction. These days will be included in the Medicare/SSI fraction, but in order for them to be counted, the hospital must submit an informational only claim (TOB 11X) which includes condition code 04 to their Medicare contractor. Refer to Change Request (CR) 6821Adobe Portable Document format.
Related Questions
- I submitted a cancel (XX8) on a claim and it returned back to me for reason code 30955 stating that the cross reference Document Control Number (DCN) is invalid. How do I correct my cancel?
- Can Condition Code 44 be used if the patient has been in the hospital more than 48 hours?
- Can claim transactions be submitted without a CDT procedure code?
